This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Tuesday, October 28, 2014

At Least One Blogger Suggests The Expert Vibes Are Suggesting It Is Time To Call Time On The PCEHR.

Call me naive, but I was hoping that somewhere in Australia IT-people would be working day and night to fix the PCEHR, based on the abundant feedback from doctors and consumers. I had a rude awakening when I read this article in Australian Doctor Magazine: PCEHR: Patients may see test results before GP.

Sorry? Diagnostic imaging & pathology results may be uploaded to someone’s eHealth record, before they have been reviewed by or discussed with the requesting doctor? This doesn’t sound like an improvement. Worse, it flies in the face of the 2014 PCEHR review recommendations to make the system ‘more usable, and able to deliver meaningful use.’

So where are we at with the PCEHR? I asked four leaders in the field about their thoughts: Has it been a success or a failure? Can it still be improved and if so, how?

Let’s get the basics right first: Frank Jones

Dr Frank Jones, President of the Royal Australian College of General Practitioners: “The concept was always good, but it failed to engage with front line medical professionals and was hijacked by lawyers. I am also really unhappy with the government’s plan to upload results if not viewed by the requesting doctor after seven days – a disastrous situation!”

“The other thing that is never talked about and that people outside GP-land are unaware of, is that GPs can already access their practice patients’ notes, anywhere, anytime. GPs leading the way again – in many ways this has diminished the value of a PCEHR at a front line GP level.”

“Lets get the basics right first: Initially we need the information such as active relevant medical issues, allergies and OTD medications.”

In its present form a failure: Brian Morton

Dr Brian Morton, Chair of the AMA Council of General Practice: “In its present form as a GP I would have to say it’s a failure. There is no recognition nor remuneration for GPs to spend the time to prepare and submit the data which must be done with the patient present. Professional clinical input to the design process has not been given the status needed to make PCEHR workable and relevant to medical practice.”

“Privacy and consumer political correctness have over-ridden safe principles of health care. The very poor uptake of the PCEHR is evidence of this. If we are to reap the benefits then recognition of the cost of data entry needs to be made.”

“Remove and prevent data which is not clinically relevant for care, for example Medicare billing data, as medical assumptions cannot be safely made based on a billing event. Identify clearly in the record that data has been removed or data hidden; the ability to over-ride the control of this is inadequate for safe care. Start the use of PCEHR with small and focused data entry such as active medical history.”

“Make a Medicare item number for the initial entry of data and an item for review yearly by the patient’s usual GP. Enable the functionality of automatic loading of diagnostic imaging & pathology data to the PCEHR when it is received and reviewed by the requesting provider. For example in our software: when it is transferred from inbox to patient record.”

----- (My comments omitted! All readers would know what I would say )

Effectively dead: David Glance

Dr David Glance, Director Centre for Software Practice, University of Western Australia: “I would say that the PCEHR is effectively dead – there is some interesting commentary here. The liberal government has not killed it but they haven’t supported it actively either. Nor have they put forward any other strategy. So given the financial climate we are in now, I don’t expect that to change.”

“I fundamentally believe that Australia has a basic structural issue when it comes to implementing central strategies around eHealth. We are still lagging in electronic record adoption in our hospitals and public health services and to a lesser extent within the specialist community. Until that changes, any shared electronic health record will always have gaps and be less than useful.”

“Clearly NEHTA needs to be disbanded and something else put in its place. It was self-serving, bureaucratic and pretty hopeless when it came down to it.”

“With regard to opt-in/opt-out, I would say that opt-out is always a better option with a far easier access mechanism than was implemented for the PCEHR. But given how awful the implementation was, the point was moot. Talking of the implementation, given what we know about user interface, you would have thought that the interface to the PCEHR could have been a lot better than it was.”

Internationally the tide is going out really fast on this kind of approach. Just a few days ago Micky Tripathi, CEO of the Massachusetts HIE and one of the biggest advocates of the HIE/PCEHR approach admitted they had got it wrong said in the press that HIEs are 'dinosaurs that are going to go away'.

Quote:"The Abbott government got off on the wrong foot with Australia's scientific sector when it failed to appoint an explicitly titled Minister for Science after its election. Reacting to the disgruntlement felt in the science community at this perceived snub, at the 2013 Prime Minister's Prizes for Science, the Prime Minister asserted that it didn't matter: that his government should be judged by its performance, not by its titles.

The Prime Minister was right. His government - all governments - should be judged by their performance and not their titles. But now a year has passed, and so it's time to do just that.

Sadly, as far as science is concerned, the Prime Minister's naming failure matches up with a fairly dismal performance as well."

As David said in this blog:http://aushealthit.blogspot.com.au/2014/10/was-asked-for-few-points-on-nehta-for.html

"6. There is no evidence I can find - after almost a decade - that any positive difference has resulted from NEHTA’s existence."

The performance of this and previous governments in the field of eHealth has been approximately zero; as measured by health outcomes. Many experts are saying so, but do they have the ear of the government? Not that I can see.

Will they do something about it? We wait and see, but I suggest you don't hold your breath. It could be bad for your health.

David, Dr David Glance states what we have known for years and documented here and in other locations that, “I fundamentally believe that Australia has a basic structural issue when it comes to implementing central strategies around eHealth. We are still lagging in electronic record adoption in our hospitals and public health services and to a lesser extent within the specialist community. Until that changes, any shared electronic health record will always have gaps and be less than useful.”With this clarity of thought his NEHTA comments have significant validity. It has been stated (despite the belief of some) that in terms if eHealth as an effective health management tool(s) Australia lags significantly behind many countries in the world. There is no perfect system (look at the critiques of EPIC out of the USA and Europe) but within many DOCUMENTED systems there are solutions which work. We must take this knowledge and experiences and adapt it to our health environment.